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The Learning

Disability
Annual Health
Check
Kevin Elliott
Clinical Lead

www.england.nhs.uk
What we know:
The average age of death
People with learning for people with a learning 37% of people with a
disabilities have poorer disability is 65 for men and learning disability die from
physical and mental health 63 for women. (Average age avoidable causes,
than other people. This is of death of 78 for men and compared with 8.8% of the
not inevitable. 83 for women in the general general population
population)

Only 49% of adults with a


Annual health checks can
learning disability on the GP
reduce health inequalities,
or health register in England
but not enough people with a
received an annual health
learning disability get them
check in 2014-15

www.england.nhs.uk
Why is it important?
• 2010 – IHAL review of the evidence shows that health checks
improve:
• the detection of unmet, unrecognised and potentially
treatable health needs (including serious and life threatening
conditions such as cancer, heart disease and dementia)
• targeted actions to address these health needs

• Recent study in The Lancet showed GP practices in the ES


had:

• increased rates of general and specific health


assessments
• increased identification of co-morbidities
• more health action plans and secondary care referrals

www.england.nhs.uk
5 Determinants of Health Inequalities
Detailed evidence reported by the Public Health Observatoryshows there to be
five discernible determinants of the health inequalities commonly experienced
by people with learning disabilities:

• Social determinants

• Genetic and biological determinants

• Communication difficulties and reduced health literacy

• Personal health behaviour and lifestyle risks

• Deficiencies in access to and quality of health provision


28/09/2017
www.england.nhs.uk
Significant health problems for
people with a learning disability
• Obesity
• Epilepsy
• Severe mental illness
• Dementia
• Diabetes
• Gastrointestinal problems eg constipation, gastro-oesophageal reflux
disorder, dysphagia
• And many others

www.england.nhs.uk
Better Health is Good for Everyone!
Everyone needs to help –
• Children, young people & adults with learning disabilities
• Families
• Paid carers
• Primary Care (GP’s)
• Learning Disability Teams
• Other health services

Everyone can make a difference

www.england.nhs.uk
What do we need to
do?
• Ensure that everyone who has a learning disability of
any age, is on the GP learning disability register –
see Mencap ‘Don’t Miss Out campaign’
https://www.mencap.org.uk/advice-and-
support/health/dont-miss-out/dont-miss-out-annual-
health-checks
• Ensure that as many people aged 14 and over have a
health check each year.
• Ensure the health check is meaningful and of good
quality
• Ensure that everyone has a health-check action plan

www.england.nhs.uk
The Learning Disability Direct
Enhanced Service
Health checks

• Practices should invite all patients on the health check register for a review of physical and mental health annually.
• As a minimum the health check should include:

• A collaborative review with the patient and carer (where applicable) of physical and mental health including: health promotion, chronic illness and
symptoms enquiry; physical examination; epilepsy, dysphagia, behaviour and mental health and specific syndrome check

• Accuracy and appropriateness of prescribed medication checked

• A review of co-ordination arrangements with secondary care

• A review of transition arrangements (where appropriate).

• A review of communication needs

• A review of family and carer needs

• Support for the patient to manage their own health and make decisions about the health and healthcare

www.england.nhs.uk
Improving the quality of the GP health
check The plan:

• Discuss the content of the health check at national level with the
General Practitioner Committee of the BMA

• Develop a National computer template for the health check ✔

• Develop guidance to go alongside the template – RCGP step-by-


step toolkit ✔

• Develop guidance for people with a learning disability, families and


carers about the importance and specific aspects of the health
check ✔

• Develop guidance for improving & monitoring quality of health


checks

• Develop guidance on training to GP practices on providing health


checks
www.england.nhs.uk
Ambitions
• Increase the number of people with a learning
disability (all ages) identified on GP registers – 10%
increase year on year

• For 75% of those on GP registers, and eligible for


AHCs, to have had one – by March 2020

• Progress monitored quarterly

• Improve Quality

www.england.nhs.uk
The National Template
There is a summary and overview on NHS England website -
https://www.england.nhs.uk/wp-content/uploads/2017/05/nat-elec-health-
check-ld-clinical-template.pdf

www.england.nhs.uk
The template
• Has a practice nurse section

• Has a GP section

• Can automatically produce an


easy read health-check action plan

www.england.nhs.uk
The health-check action plan

www.england.nhs.uk
The final message!
We all have to work together to ensure that:

• People with a learning disability and their carers understand the benefit of the
health check
• People are proactive in asking for a check
• GP practices are well organised to make it work for people
• The health check action plan is meaningful
• Community learning disability teams support the process

www.england.nhs.uk
Thank you for listening!
Resources:

• For more information on NHS England’s Learning Disability Programme - https://www.england.nhs.uk/learning-


disabilities/

• Mencap ‘Don’t miss out” - https://www.mencap.org.uk/advice-and-support/health/dont-miss-out/dont-miss-out-guides

• NDTi & VODG guide for Social Care staff -https://www.ndti.org.uk/resources/publications/better-health-for-people-with-


learning-disabilities

• RCGP Step by Step guide - http://www.rcgp.org.uk/clinical-and-research/toolkits/health-check-toolkit.aspx

• National Learning Disability Health Check - https://www.england.nhs.uk/gp/gpfv/investment/gp-contract/

• Summary Care Records with Additional Information-


http://webarchive.nationalarchives.gov.uk/20160921135209/http://systems.digital.nhs.uk/scr/additional

• Delivering high quality end of life care for people with a learning disability. Resources and tips for commissioners,
service providers and health and social care staff. - https://www.england.nhs.uk/publication/delivering-high-quality-end-
of-life-care-for-people-who-have-a-learning-disability/

• STOMP information - https://www.england.nhs.uk/learning-disabilities/stomp/


www.england.nhs.uk
Things being developed
• Diabetes Pathway – due to be published

• UCL Report – Social Determinates of Health Inequalities - draft

• PHE – Improved Screening for vulnerable groups - starting

• Flagging project – NHS Digital & NHS England

• End of Life Guide

• Point of Contact – diagnostics (Lab in a Bag)

• Understand People’s Health Needs – Data into intelligence - AHC, GP


registers & beyond

• Reasonable Adjustment Standards

• Regional workshops about AHCs for GPs & commissioners

www.england.nhs.uk